摘要
目的探讨环孢素A(cyclosporine A,CsA)对体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)周期不明原因反复种植失败(unexplained repeated implantation failure,URIF)患者再次胚胎移植临床结局的影响。方法采用回顾性队列研究对2016年4月至2020年3月期间在南京医科大学附属苏州医院生殖与遗传中心接受胚胎移植的IVF/ICSI周期URIF患者资料进行分析,接受CsA治疗(CsA组)的94个周期,按年龄、体质量指数(body mass index,BMI)、基础卵泡刺激素(follicle-stimulating hormone,FSH)、移植优质胚胎数和胚胎期别配对选取未接受CsA的对照组188个周期,比较两组患者的一般情况、移植周期特征、临床结局、产科及新生儿结局,并对CsA与临床结局进行回归分析。结果①两组的年龄、BMI、基础FSH、不孕年限、不孕原因、既往失败次数、移植优质胚胎数、囊胚移植率等基线特征差异均无统计学意义(均P>0.05),再次移植周期的胚胎数、优质胚胎数、囊胚移植率和移植日子宫内膜厚度差异均无统计学意义(均P>0.05)。②CsA组的胚胎种植率[53.39%(63/118)]、临床妊娠率[58.51%(55/94)]、活产率[45.74%(43/94)]明显高于对照组[38.43%(93/242)、45.74%(86/188)、33.51%(63/188)],差异均有统计学意义(P=0.007、P=0.043、P=0.046);CsA组和对照组的流产率、异位妊娠率差异均无统计学意义(均P>0.05)。③两组早产率、双胎率、产科并发症率、新生儿并发症率差异均无统计学意义(均P>0.05),两组均未观察到出生缺陷。④logistic回归分析结果显示,在纠正了年龄、BMI、基础FSH、移植优质胚胎数和移植日子宫内膜厚度后,CsA仍是URIF患者临床妊娠(校正后OR=1.694,95%CI:1.019~2.816,P=0.042)和活产(校正后OR=1.700,95%CI:1.012~2.853,P=0.045)的独立促进因素。结论CsA显著提高了URIF患者再次胚胎移植的胚胎种植率、临床妊娠率和活产率,并且不增加产科和儿科并发症的风险。CsA可能是URIF患者的一种有效的治疗手段。
Objective To explore the effects of cyclosporine A(CsA)on the clinical outcomes of patients with unexplained repeated implantation failure(URIF)undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)cycles.Methods A retrospective cohort study was conducted,and the data of URIF patients at the Center for Human Reproduction and Genetics of the Affiliated Suzhou Hospital of Nanjing Medical University from April 2016 to March 2020 was analyzed.Totally 94 cycles with CsA application were enrolled,and 188 cycles of control group were selected according to age,body mass index(BMI),basal follicle-stimulating hormone(FSH),the number of high-quality embryos transferred and embryo stage matched with CsA group.The general conditions,characteristics of previous failed transfer cycles and the de novo transfer cycles,clinical outcomes,obstetric and neonatal complications were compared between the two groups,and regression analysis of CsA and clinical outcomes.Results 1)There were no statistical differences between the two groups in baseline characteristics such as age,BMI,basal FSH,duration of infertility,indications for IVF/ICSI,number of previous failed cycles,number of high-quality embryos and blastocyst transferred rate(all P>0.05).There were also no significant differences in the number of embryos transferred,the number of high-quality embryos,the rate of transferred blastocyst and the endometrial thickness on transfer day of the de novo transfer cycles(all P>0.05).2)The embryo implantation rate,the clinical pregnancy rate and the live birth rate in CsA group[53.39%(63/118),58.51%(55/94),45.74%(43/94)]were distinctly higher than those of control group[38.43%(93/242),45.74%(86/188),33.51%(63/188)].The differences were statistically significant(P=0.007,P=0.043,P=0.046).While there were no differences in miscarriage rate and ectopic pregnancy rate between the two groups(all P>0.05).3)The differences of the rates of preterm birth,multiple pregnancy,obstetric and neonatal complications were all not statistically significant between the two groups(all P>0.05).No birth defects were observed in both groups.4)The multivariate logistic regression analysis showed that CsA was an independent promoter of clinical pregnancy(after adjusted OR=1.694,95%CI:1.019-2.816,P=0.042)and live birth(after adjusted OR=1.700,95%CI:1.012-2.853,P=0.045)in URIF patients after adjusting for age,BMI,basal FSH,the number of embryos transferred and the endometrial thickness on transfer day.Conclusion CsA showed remarkably enhancement on embryo implantation rate,clinical pregnancy rate and live birth rate of de novo embryo transfer in patients with URIF,without increasing the risk of obstetric and pediatric complications.CsA application may be used as an effective treatment for URIF patients.
作者
成伟
吴亚男
吴惠华
邹琴燕
李红
朱蕊
Cheng Wei;Wu Yanan;Wu Huihua;Zou Qinyan;Li Hong;Zhu Rui(Center for Human Reproduction and Genetics,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Gusu School,Nanjing Medical University,Suzhou 215004,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2023年第3期253-260,共8页
Chinese Journal of Reproduction and Contraception
基金
苏州市临床医学专家团队引进项目(SZYJTD201708)
姑苏卫生重点人才项目(GSWS20190018,GSWS2020060)
苏州市民生科技示范项目(SS202005)
南京医科大学姑苏学院课题(GSKY20210206,GSKY20210402)。
关键词
环孢素A
不明原因反复种植失败
胚胎种植率
临床妊娠率
活产率
Cyclosporine A
Unexplained repeated implantation failure
Implantation rate
Clinical pregnancy rate
Live birth rate
